The Cardiovascular Health Study (GHS) is an NHLBI-funded cohort study of risk factors for coronary heart disease (CHD) and stroke in adults 65 years or older. In the early 1990s, 5888 participants underwent examinations that included traditional risk factors and measures of sub-clinical disease. During follow-up, many exam components were repeated, and CVD events were ascertained. In response to an investigator-initiated proposal, the NHLBI has extended CHS contract funding (1) to implement a model for a transition from contract-funding to investigator-initiated research and (2) to enhance access to CHS data for future papers and ancillary studies by CHS and non-CHS colleagues. The proposed R01, designed to continue events follow-up, will provide a foundation for the transition. Current and future papers and ancillary studies using CHS data or stored specimens will have additional power and can be conducted more efficiently if a service events-core continues to collect and adjudicate CVD events and deaths in a standardized fashion. The proposed study will provide important information about the determinants of CVD in older adults. For adults 80 years and older, few data are available on CVD incidence rates, on risk factors for CVD events, and on differences among subgroups defined by sex, race and age. Structurally, the primary aims are: (1) to evaluate the incidence rates of and risk factors for CVD in older adults, including comparisons between blacks and whites, men and women, young old and old; (2) the evaluation of prognosis in inception cohorts of older adults with new-onset conditions such as heart failure (HF) and a trial fibrillation; and (3) the evaluation of associations between risk-factor change and the incidence of subsequent events. Questions of interest include: What are the determinants of the low CHD incidence in women 80 yrs and older? Do older black women also have a low CHD incidence? What are the determinants of CHD, HF, and stroke in adults 80 and older? Are risk factors different between men and women, whites and blacks? Do traditional risk factors and measures of sub-clinical disease continue to be powerful predictors of CHD, HF and stroke in those 80 and older? In this study, we expect to make over 20,000 phone calls to identify 6000 hospitalizations, 1000 deaths, 3000 events for detailed review, and 1500 new events, including 370 CHD, 300 stroke, and 450 HF. These new events represent an increase in the number of CVD events of 29% to 35% in whites and an increase of 40% to 49% in blacks. The data and specimens collected in CHS represent a major national resource for the study of health, aging, and cardiovascular disease in older adults. Additional events follow-up will not only provide the opportunity to address the aims of this study, but also enhance the power of current and future CHS papers and ancillary studies by CHS and non-CHS colleagues. [unreadable] [unreadable]